FROM JAMA

Forgoing androgen deprivation therapy cuts rather than raises overall and cardiac mortality in certain patients with prostate cancer, depending on their comorbidities, according to a Research Letter to the Editor published online Sept. 22 in JAMA.

Currently, 6 months of androgen deprivation therapy (ADT) plus radiotherapy is the standard treatment for unfavorable-risk localized prostate cancer. However, concerns have been raised as to whether men with moderate to severe comorbidity show a survival benefit with the added ADT, and even whether the treatment potentially raises their cardiac risk, said Dr. Anthony V. D’Amico of the department of radiation oncology, Brigham and Women’s Hospital, Boston, and his associates.

To examine this issue, the investigators analyzed survival outcomes among 206 men treated for unfavorable-risk prostate cancer at three academic and three community-based Massachusetts medical centers in 1995-2001. A total of 157 men had no or minimal comorbidity, while the remaining 49 had moderate or severe comorbidity. These study participants were randomly assigned to receive radiotherapy alone (104 patients) or radiotherapy plus ADT (102 patients).

After a median follow-up of 16.6 years, 156 of the men (76%) had died. Twenty-nine died of prostate cancer (19%), 39 of cardiac causes (25%), and 88 of other causes (56%). Survival did not differ between the group given radiotherapy alone and the group given additive ADT. However, survival did differ according to comorbidity profiles, the investigators said (JAMA. 2015 Sep 22;314:1291-3). http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2015.8577.

Among men with no or minimal comorbidity, adding ADT to radiotherapy actually increased overall mortality (hazard ratio, 1.51) and prostate cancer mortality (HR, 4.30), had no effect on cardiac mortality (HR, 1.72), and decreased mortality from other causes (HR, 0.60). Conversely, among men with moderate or severe comorbidity, forgoing rather than receiving additive ADT decreased overall mortality (HR, 0.36) and cardiac mortality (HR, 0.17), had no effect on prostate cancer mortality (HR, 2.41), and increased mortality from other causes (HR, 2.79). These findings indicate that adding ADT to radiotherapy “should be carefully considered” in patients who have moderate or severe comorbidity, Dr. D’Amico and his associates said.

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